Maternal reasons for requesting planned cesarean section in Norway: a qualitative study

Kristiane Tislevoll Eide,Kristine Bærøe,Nils-Halvdan Morken

doi:10.1186/s12884-019-2250-6

Kristiane Tislevoll Eide, Kristine Bærøe + Show 1 more

Open Access

https://doi.org/10.1186/s12884-019-2250-6

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Abstract

BackgroundPregnant women who request a cesarean section in the absence of obstetric indication have become a highly debated issue in academic as well as popular literature. In order to find adequate, targeted treatment and preventive strategies, we need a better understanding of this phenomenon. The aim of this study is to provide a qualitative exploration of maternal requests for a planned cesarean section in Norway, in the absence of obstetric indications.MethodsA descriptive qualitative study was conducted consisting of 17 semi-structured, in-depth interviews with women requesting cesarean section and six focus group discussions with 20 caregivers (nine midwives, 11 obstetricians) working at a university hospital in Norway. Data were analyzed with Systematic Text Condensation, a method for thematic cross-case analysis.ResultsFear of birth emerged most commonly as a result of a previous traumatic birth experience that prompted a preference for a planned cesarean to avoid a repetition of the trauma. For some women in our study, postnatal care and the puerperal period were their crucial past experiences, and giving birth by planned cesarean was seen as a way to ensure mental rather than physical capability to care for the expected child after birth. Others were under the impression of being at high risk for an emergency C-section, and requesting a planned one was based on their perceived risk. Such perceptions included having a narrow pelvis, hereditary factors or previous birth outcomes. Some primiparas requested a planned cesarean based on a deep-seated fear since their early teens, accompanied by alienation towards the idea of giving birth. Some obstetricians participating in our study also experienced requests that lacked what they regarded as any well-grounded reason or significant fear.ConclusionsBehind a maternal request for a planned cesarean section are various rationales and life experiences needing carefully targeted attention and health care. Previous births are an important driver; thus, maternally requested cesareans should be regarded partly as an iatrogenic problem.

Highlights

Pregnant women who request a cesarean section in the absence of obstetric indication have become a highly debated issue in academic as well as popular literature
cesarean section (CS) on maternal request (CSMR) is defined as a planned CS conducted on maternal request when there is no obstetric contraindication for vaginal delivery [3]
Fourteen women were multiparous women who had not requested a cesarean section in a previous pregnancy

Summary

Introduction

Pregnant women who request a cesarean section in the absence of obstetric indication have become a highly debated issue in academic as well as popular literature. The rationale for many women was to avoid mental health problems following a traumatic birth experience. Fear of birth due to previous birth experience was the dominant reason for cesarean requests among the women in this study. Our findings suggest that it is not the previous CS but rather the negative aspects of the birth experiences, which are crucial in their justification of a cesarean request. Presence of a previous negative birth experience was the strongest predictor of fear, followed by impaired mental health and lack of social support. Fear of birth due to previous traumatic birth experience can be prevented through proper midwifery and perinatal mental health care [28]. Women and caregivers interviewed in this study suggested postpartum follow-up after birth as a way of avoiding cesarean requests in subsequent pregnancies. Women seem to appreciate such services and midwives regard it as beneficial for women [32]

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